Determinant factors for the occurrence of tuberculosis after initiation of antiretroviral treatment among adult patients living with HIV at Dessie Referral Hospital, South Wollo, Northeast Ethiopia, 2020. A case-control study

Abstract

Introduction Globally, tuberculosis takes the first rank for the ill-health of people living with HIV/AIDS. Despite the favorable outcome of antiretroviral therapy, the risk of tuberculosis remains higher among HIV patients. This obliges to identify factors for its occurrence and further prevention of drug-resistant tuberculosis. There is a contradiction between different studies and studies conducted in Ethiopia studied poorly the association between adherence to antiretroviral therapy and viral load with tuberculosis. Studies conducted in the study area were limited to cross-sectional study design. Therefore, this study claimed to identify factors determining the occurrence of tuberculosis after initiation of antiretroviral therapy. Methods This study was conducted at Dessie Referral Hospital by using a case-control study design on a sample of 565 with a control: case ratio of 3:1. Participants from controls were selected by systematic random sampling and from cases by consecutive random sampling. The data were collected by interviewing through structured questionnaires and from the medical record. The data were entered into Epi data version 3.1. In the multivariable analysis, variables with a P-value of ≤0.05 were anticipated as independent determinant factors. Result Patients without separate kitchen (AOR: 3.547, 95% CI: 2.137, 5.888), having opportunistic infection (AOR: 3.728, 95% CI: 2.058, 6.753), CD4 count of <350 cells/mm3 (AOR: 3.383, 95% CI: 1.520, 7.528), baseline WHO stage III (AOR: 3.321, 95% CI: 1.688, 6.534) or IV (AOR: 2.900, 95% CI: 1.251, 6.722), don’t taking IPT (AOR: 3.701, 95% CI: 2.228, 6.147) and those who were poorly adherent (AOR: 2.626, 95% CI: 1.272, 5.423) or moderately adherent (AOR: 3.455, 95% CI: 1.885, 6.335) to anti-retroviral therapy were more likely to develop tuberculosis after anti-retroviral therapy initiation. Conclusion Poor housing conditions, having an opportunistic infection, low CD4 count, starting ART at the advanced HIV stage, don’t take IPT, and being poorly adherent to antiretroviral therapy were associated with the occurrence of TB after initiation of ART. The institution should screen for TB as early as possible and strictly follow their drug adherence.

Bayesian Parametric Modeling of Time to Tuberculosis Co-Infection of HIV/AIDS Patients Under Antiretroviral Therapy Treatment at Jimma University Medical Center, Ethiopia

“…Our findings showed alcoholic patients were more likely to co-infected with TB compared non-alcoholic patients. This finding is consistent with the reports of Ahmed et al and Abdu et al [55,61].…”

“…This result agrees with the result reported by Anye et al based on four year retrospective data of 1077 HIV patients in the Bameda regional hospital of Cameroon [60]. Our result also agrees with report of studies undertaken in Ethiopia [55,59,61]. Their results suggested that being smoker is significantly associated with TB co-infection free survival time in HIV/AIDS patients.…”

Incidence and predictors of Tuberculosis among patients enrolled in Anti-Retroviral Therapy after universal test and treat program, Addis Ababa, Ethiopia. A retrospective follow -up study

“…This can be explained by patients with poor adherence to ART are prone to rapid viral replication which worsen immunological and clinical outcomes. This leads to declining of CD4 cell count which will end up with high risk of developing opportunistic infections including TB [ 28 , 29 ].…”

Nonadherence Predictors to Tuberculosis Medications among TB Patients in Gambella Region of Ethiopia

“…However, barriers to adherence are complex and need multifactorial remedies [ 22 ]. TB patient commitment and abilities are linked to various determinants; such as patients' own factors, social and economic factors, healthcare workers (HCWs) factors, the health system, characteristics of the disease, and disease therapies [ 23 ]. Consequently, addressing the gap in TB patients' nonadherence to treatment is crucial for the welfare of the community as TB requires a long duration of treatment [ 24 ].…”